Reimbursement for Home Perimetry (KYS)
FREQUENTLY ASKED QUESTIONS:
REIMBURSEMENT FOR HOME PERIMETRY
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Q What are Peristat™ and Macustat™?
A Peristat™, to test visual field function, and Macustat™, to test macular function, are cloud-based automated perimetry digital diagnostic applications that run remotely on connected laptop or tablet devices. These on-demand home tests may be used in two ways: 1) as part of a screening program in a community outreach effort, and 2) to test visual function in patients with chronic diseases such as glaucoma, AMD, or diabetic macular edema. Home testing can be valuable for patients who have difficulty coming to the office.
Q What regulation governs Medicare coverage of perimetry?
A Perimetry is covered under a National Coverage Determination policy on “Computer Enhanced Perimetry” (NCD 80.9). Also, at the time of this writing, four Medicare Administrative Contractors (MAC) have Local Coverage policies for visual fields testing.2,3,4,5
Q Does Medicare cover screening or preventative home perimetry?
A No. Section 1861(uu) of the Social Security Act defines “screening for glaucoma” as a covered service which “means a dilated eye examination with an intraocular pressure measurement, and a direct ophthalmoscopy or a slit lamp biomicroscopic examination for the early detection of glaucoma.” Home perimetry does not fall within this meaning.1
Q Does Medicare cover physician ordered home perimetry for patients with chronic disease?
A Yes, for eligible diseases and conditions in the payer’s coverage policy.
Q What CPT codes describe visual field testing with Peristat and Macustat?
A Peristat and Macustat use a suprathreshold testing protocol. In CPT, this is reported with 92082 – intermediate visual field.
Q For eligible services, how is a claim filed?
A Perimetry, or visual field testing, has two parts: a technical component (TC) and a professional interpretation (26). Only the professional interpretation (i.e., 92082-26) is claimed and reimbursed using place of service office (11). Claims for visual field testing are not payable under Part B Medicare for place of service home (12).6
Q What documentation is required in the medical record for a test that is eligible for reimbursement?
A Without regard to where the test is performed, the chart notes should contain the test results and the following elements.
- An order (in advance of test performance) for the test with medical rationale
- Date of the test
- Reliability of the test (e.g., fixation losses)
- Test findings (e.g., scotoma, COAG)
- Comparison with prior test(s) if applicable
- A diagnosis (if possible)
- Impact on treatment and prognosis
- Signature of the physician and date
Q How frequently may I perform home perimetry?
A Generally, visual tests may be repeated as often as is medical necessary. Some reasons are:
- During the eye exam that precedes the order for a test, the physician decides that the patient’s condition has changed for the worse due to:
- objective evidence of vision loss
- new symptoms or complaints
- a recent surgical intervention
- exam findings of disease progression
- The results of an earlier test are no longer reliable.
- The AAO’s Preferred Practice Patterns suggest repeat testing at intervals which vary based on the disease and its progression.
Q How much does Medicare allow for the physician interpretation of 92082?
A The 2020 national Medicare Physician Fee Schedule allowable amount is:
This amount is adjusted by local wage indices. Other third party payers set their own rates, which may differ significantly from Medicare’s fee schedule.
1 Social Security Act §1861(uu). Link here.
2 CGS Administrators, LLC. Local Coverage Article (LCA) #A56799. Rev. Eff. Date 09/19/2019. Link here.
3 First Coast Service Options, Inc. Local Coverage Article (LCA) #A57637. Rev. Eff. Date 10/03/2018. Link here.
4 Wisconsin Physicians Service Corporation. Local Coverage Article (LCA) #A57483. Rev. Eff. Date 10/31/2019. Link here.
5 National Government Services, Inc. Local Coverage Article (LCA) #A56551. Rev. Eff. Date 08/01/2019. Link here.
6 Representative policy from Wisconsin Physicians Service Corporation. Local Coverage Article (LCA) #A57483. Rev. Eff. Date 10/31/2019. Link here.
Provided Courtesy of KeepYourSight Foundation (800) 205-2786
Last updated December 1, 2020
The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.
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